The Value Of BISAP Score,Neutrophil To Lymphocyte Ratio And Blood Urea Nitrogen In Early Predicting The Severity Of Acute Pancreatitis

Objective:The aim of the study is to explore the value of the Bedside Index of Severity in Acute Pancreatitis(BISAP)score,NLR(Neutrophil to Lymphocyte Ratio),and blood urea nitrogen in predicting the severitity of acute pancreatitis,and develop a model able to predict Severe Acute Pancreatitis early.Methods:In the study,188 patients diagnosed as acute pancreatitis from June 2017 to June 2018 in China-Japanese Union Hospital of Jilin University were collected.Including basic data of each patient,vital signs and laboratory serological results(neutrophil count,lymphocyte count,blood urea nitrogen,etc.),and calculating BISAP score,and NLR.These patients were classified into SAP group,and non-SAP group included MAP and MSAP,based on the classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions.The general characteristics of the two groups of patients were compared and analyzed.Kendall’s tau-b correlation analysis was used to compare the correlation between BISAP score,blood urea nitrogen,NLR and the severity of acute pancreatitis severity.Then,Bring statistically significant variables from univariate analysis into binary logistic regression analysis and develop a model for early prediction of SAP.According to the area under the receiver operating characteristic curve(AUC)of model,BISAP score,blood urea nitrogen,and NLR to evaluate the performance of predictions.The area under the ROC curve between the model and each indicator was compared with the z test.The cutoff value was selected according to the method of the largest Yoden index,and the sensitivity,specificity,positive predictive value,and negative predictive value of each cutoff value were calculated.Results:Analysis of the basic characteristics of 188 patients diagnosed as acute pancreatitis,biliary causes accounted for 44.7% is the main cause of acute pancreatitis,hyperlipidemia pancreatitis accounted for 28.7%,alcoholic pancreatitis and other causes accounted for 11.2% and 15.4%,there was no statistical difference in the etiological distribution between the two groups(P >0.05).Analysis of the clinical characteristics of the two groups,BISAP score,blood urea nitrogen,SIRS,NLR,serum creatinine,serum calcium and lactate dehydrogenase between the two groups were statistically significant(P <0.05).Kendall’s tau-b correlation analysis showed that the correlation coefficients of BISAP score,urea nitrogen,SIRS,NLR,serum creatinine,serum calcium and lactate dehydrogenase were 0.353,0.275,0.271,0.268,0.181,-0.160,0.141.Correlation coefficient intensity: BISAP score> blood urea nitrogen>SIRS>NLR> serum creatinine > serum calcium>lactate dehydrogenase,in which blood calcium is negatively correlated with the severity of acute pancreatitis,and other variables are positively correlated with the severity of acute pancreatitis.Univariate analysis showed that BISAP score,NLR,and blood urea nitrogen were independently correlated with SAP.The above variables were included in the binary logistic regression.Based on the results of logistic regression analysis,a logistic regression model for predicting SAP was established(the following named as the model),the specific formula is as follows:-4.536 + 0.079 × NLR + 0.24 × blood urea nitrogen(mmol/L).The area under the ROC curve(AUC)was used to evaluate the predictive power of each indicator for SAP.The model(AUC=0.862)predicting SAP was superior to BISAP score(AUC=0.773),NLR(AUC=0.748),and urea nitrogen.(AUC=0.754),(P <0.05).Conclusions:1.Biliary factors are still the main cause of acute pancreatitis,and hyperlipidemia pancreatitis is the second.2.BISAP score,NLR,and blood urea nitrogen have higher predictive value for the severity of acute pancreatitis.3.The predictive value of the model composed wih blood urea nitrogen and NLR for the severity of acute pancreatitis is better than BISAP score,NLR,and blood urea nitrogen.